[Limited reserve of corticotropic hormone (ACTH)]. / Reserva limitada de hormona corticotropa (ACTH).

Chronic deterioration of the glucocorticoid function may result from a primary disorder of the suprarenal glands; from a deficit of the corticotropic hormone (ACTH) due in most cases to an extended hypophyseal affection with reduced secretion of other hypophyseal hormones and from the lack of corticotropin releasing hormone (CRH) at the hypothalamic level. Isolated ACTH deficiency is a rare clinical entity. A subgroup within this pathology is the limited reserve of ACTH which would constitute a mild form of dysfunction in the corticotropic cells, with enough secretion of ACTH to maintain a normal adrenal function in the absence of stress-inducing situations, but unable to show an appropriate reaction in such situations. The difference between these two entities lies in the normal levels of 17-OH-corticosteroids in the limited reserve of ACTH. We describe the case of a patient with acute severe hyponatremia in whom this rare affection was diagnosed and we make some considerations regarding this entity.

[Erythroderma caused by carbamazepine. Diagnosis with skin patch]. / Eritrodermia por carbamacepina. Su diagnóstico mediante parche cutáneo.

We present two cases of cutaneous erythroderma induced by carbamazepine therapy, both cases with just cutaneous affection and only one suspicious drug. A cutaneous patch study, with standard battery from the Spanish Contact Dermatitis Research Group, vaseline with carbamazepine at 10% and lectures at 48 and 96 hours, was conducted. The result was positive for carbamazepine and negative for all other patches in both cases. All controls were negative. This is a very simple test, easy to perform, specific and with low side effects, allowing the diagnosis of this pathology.

Epidemiologic status of drug abuse in Mexico.

Abuse of alcoholic beverages and tobacco appear to constitute priority public health problems in Mexico, while abuse of other drugs is sufficiently widespread to justify concern. More specifically, a recent national survey (11) found that over 10% of the male subjects 18 to 65 years old met established international criteria for alcohol dependence, while about a quarter of those surveyed were active smokers. A total of 4.3% said they had used one or more drugs other than tobacco or alcohol at some time in their lives.

[Epidemiological status of drug abuse in Mexico]. / Situación epidemiológica del abuso de drogas en México.

As a country that produces marijuana and opium, and as a route for cocaine traffic to the United States of America, Mexico is experiencing serious social and health problems related to the trafficking, use, and abuse of these drugs and other dependency-producing substances. In 1988 a national survey of addiction was undertaken in which information was collected on the prevalence of the use of alcohol, tobacco, inhalants, marijuana, cocaine, hallucinogens, opium, heroin, narcotic analgesics, sedatives, and tranquilizers. A sample was identified in the population between the ages of 12 and 65 living in urban areas of more than 2,500 inhabitants, which account for approximately 65% of the country's total population. This sample consisted of 12,557 persons. According to the results of the survey, 51% of the population between 18 and 65 years of age use alcoholic beverages and 24.7% of the entire study population are active smokers. In addition, 43% had used one or more drugs other than tobacco or alcohol at some time. Prevalence of marijuana use was 2.6%, while the rates for tranquilizers, inhalants, and amphetamines were identical (0.7%). For cocaine the rate was 0.3%, and for heroin, 0.1%.

[Chagas' disease in patients with renal transplantation]. / Enfermedad de Chagas en trasplantados renales.

After observing a fatal chagasic infection in a renal transplant recipient we investigated Chagas disease in 84 recipients of renal transplants. The indirect hemagglutination test was used for screening and xenodiagnosis followed in positive cases, along with ECG and gastrointestinal X ray series. Nine cases were detected (10%); parasites were found in the blood of 6 of them (66%). No patient had cardiac or gastrointestinal involvement. Patients with a positive serology were treated with nifurtimox (2) or benzonidazol (7); xenodiagnosis every 6 months up to 67 months remains negative in these patients. Blood transfusions are suspected as the mechanism for infection in these cases.